Black borrowers face highest levels of medical debt

At a time when much political debate is focused on the high cost of healthcare, researchers at UC Berkeley School of Public Health have shown that medical debt is not distributed equally.

An analysis of credit reports for nearly 24 million adults ages 18-64 from 2016 to 2022 showed that Black Americans consistently had the highest rate of referrals to collection agencies for medical bills and the highest accumulated medical debt in collections, compared to Hispanic, white, and Asian and Pacific Islander borrowers.

The study, published in May 2026 in Health Affairs Scholar, noted that in 2016, 15.6 % of Non-Hispanic Black borrowers had new medical debt in collections. In 2022, the number declined to 11.2%—in keeping with the nationwide reduction in medical debt collections—but remained higher than other racial groups examined. Hispanic borrowers had the second highest percentages of medical debt referrals to collection agencies, at 8.7% in 2016 and 6.5% in 2022.

In contrast, Non-Hispanic White borrowers went into medical debt collections at a rate of 8.6% in 2016, declining to 5.9 % in 2022. Non-Hispanic Asian and Pacific Island borrowers had the lowest percentage of borrowers referred to collections, at 1.8% in 2016 and 1.2% in 2022.

States that expanded Medicaid over the study period had lower debt levels, although the Black borrowers remained overrepresented in debts sent to collection agencies.

“These results represent a somber yet expected result of well-documented differences across health and finances,” the authors wrote. “Importantly, medical debt may also be part of a cyclical relationship whereby medical debt contributes to both worse health and overall finances. When medical debt is accrued, it may lead to further barriers to health-promoting activities and increase financial instability.”

Alexander C. Adia, a doctoral candidate at Berkeley Public Health, and lead author of the paper, said that if left unaddressed, medical debt may exacerbate health disparities, making the need to understand differences in debt by race and ethnicity critical for informing policy.

“For many health systems, the amount of any given bill might just be a rounding error in their budget,” said Adia. “But for individual patients, even those who have insurance coverage, that bill could be something that could bankrupt them, or force them to juggle their finances in a way that means they go without addressing other basic needs because of their debt.”

Adia conducted the study with UC Berkeley School of Public Health researchers Dr. Jenny S. Guadamuz, assistant professor of Health Policy and Management and director of the Health Equity Research Program, and Dr. Hector P. Rodriguez, professor of Health Policy and Management and co-director of the Center for Health Management and Policy Research.

“For me, as a health equity researcher, I think of medical debt as a consequence of inequity,” Adia said. “Racially minoritized groups face significant barriers to accumulating the same amount of wealth, or making the same income as others. And that ultimately might mean that you show up to the health care system sicker, and then you might struggle a little more with paying for that debt.”